{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"PHYLLIS PRINCE","gend":1,"add":"7104 NEW MUNSTER RD","city":"MECHANICSVILLE","state":"VA","zip":"23111-9998","dob":"1948-07-19","age":"","mstatus":"","insh":"11008324","cliId":"","pno":8045597577,"cno":"","email":"","ename":"","eno":"","pphy":"FOSTER, BRIAN J","ppno":8047641253,"pcpadd":"8220 Meadowbridge Rd Ste 203","pcpcity":"Mechanicsville","pcpstate":"VA","pcpzip":231162339,"pcpcounty":"","pcpid":"","pcpname":"LABURNUM MEDICAL CENTER","plan":"VPHP","program":"MEDICARE","lob":"DSNP","region":"CENTRAL","aligned":"Y","ano":"","add2":"APT 213","add3":"","madd1":"7104 NEW MUNSTER RD","madd2":"APT 213","madd3":"","mcity":"MECHANICSVILLE","mstate":"VA","mzip":"23111-9998","pcpfaxno":"","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":[]}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","00003089421","ELIQUIS ","5MG","60.00","Select","Select",""],["","10702001150","HYDROXYZ ","25MG","30.00","Select","Select",""],["","65862007601","CIPROFLOXACN ","250MG","10.00","Select","Select",""],["","00074455290","SYNTHROID ","50MCG","90.00","Select","Select",""],["","00173069600","ADVAIR ","250\/50","180.00","Select","Select",""],["","65862050320","AMOX\/K ","875-125","20.00","Select","Select",""],["","59746000103","METHYLPRED ","4MG","21.00","Select","Select",""],["","65162083366","DICLOFENAC ","1%","100.00","Select","Select",""],["","10702001801","OXYCODONE ","5MG","30.00","Select","Select",""],["","65862086001","FAMOTIDINE ","40MG","90.00","Select","Select",""],["","68180012202","CEPHALEXIN ","500MG","28.00","Select","Select",""],["","76385011150","CARVEDILOL ","6.25MG","180.00","Select","Select",""],["","72578008801","NYSTAT\/TRIAM ","","15.00","Select","Select",""],["","45802046564","KETOCONAZOLE ","2%","120.00","Select","Select",""],["","63304069301","CLINDAMYCIN ","300MG","21.00","Select","Select",""],["","00054327099","FLUTICASONE ","50MCG","48.00","Select","Select",""],["","59651000305","OMEPRAZOLE ","40MG","90.00","Select","Select",""],["","00185012801","BUMETANIDE ","0.5MG","90.00","Select","Select",""],["","00093727098","PRAVASTATIN ","80MG","90.00","Select","Select",""],["","00254200801","COLCHICINE ","0.6MG","30.00","Select","Select",""],["","66993096045","METRONIDAZOL ","0.75%","45.00","Select","Select",""],["","67877025145","TRIAMCINOLON ","0.10%","454.00","Select","Select",""],["","55111072901","ALLOPURINOL ","100MG","90.00","Select","Select",""],["","58160082311","SHINGRIX ","50\/0.5ML","1.00","Select","Select",""],["","65862039010","ONDANSETRON ","4MG ODT","15.00","Select","Select",""],["","00378877035","ESTRADIOL ","0.01%","42.50","Select","Select",""],["","43598029290","PREGABALIN ","50MG","60.00","Select","Select",""],["","49281040565","FLUZONE ","PF 19-20","0.50","Select","Select",""],["","00603533815","PREDNISONE ","10MG","21.00","Select","Select",""],["","13107008405","LORAZEPAM ","1MG","2.00","Select","Select",""],["","49281072010","FLUBLOK ","2020-21","0.50","Select","Select",""],["","67877021660","CEFUROXIME ","500MG","10.00","Select","Select",""],["","00378932132","WIXELA ","250\/50","60.00","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":{"indx":["","1"],"comment":["",""]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}